Since 2015, PrEP has been recommended by WHO as a prevention tool for people at high risk of HIV infection, including men who have sex with men (MSM). Although the effectiveness of pre-exposure prophylaxis has been widely demonstrated, its deployment is not optimal. Also, scientific teams from AP-HP, Inserm, Paris Cité University, Sorbonne University and Aix-Marseille University have carried out a study, for 3 yearswith 3,056 volunteers, to compare the efficacy, compliance and safety of daily or on-demand PrEP in the prevention of HIV-1.
For this study, which took place between May 2017 and May 2019, in the Paris region (one of the regions of France with the most new annual HIV infections), the researchers selected 98.7% of men who have sex with men (MSM) and 1.3% of transgender women who have sex with men, all of whom were at high risk of HIV infection. Participants could freely take daily PrEP (regime chosen by 50.5% of volunteers) or on demand (regime chosen by 49.5% of volunteers).
Every three months, participants received follow-up with counseling on PrEP adherence and risk reduction from a peer, HIV testing, and self-reporting of adherence to PrEP. Prep. They were also offered free condoms and lubricating gel as well as testing and treatment for STIs.
Many HIV infections averted…
During the entire follow-up period, 6 HIV infections were reported: 3 in each group. These six participants had stopped PrEP a few weeks or months before the diagnosis of HIV. The researchers estimated that 361 infections were averted.
“Oral PrEP with tenofovir disoproxil and emtricitabine on-demand is an effective and safe alternative to daily PrEP in MSM and offers greater choice in HIV prevention. However, MSM make up only 43% of new HIV diagnoses in France. It is therefore crucial to continue research to evaluate this on-demand regimen in other high-risk groups and with different combinations of antiretroviral molecules” explains Pr Jean-Michel Molina, from the Department of Diseases infectious and tropical diseases from the Saint-Louis and Lariboisière hospital, the main author of the study.
… but an increase in STIs
Other infections were reported during the study period, including 43 cases of viral hepatitis (mostly hepatitis C) and bacterial STIs (chlamydia, gonorrhea, Mycoplasma genitaliumsyphilis).
“The number of sexual intercourse without a condom reported in this study could explain these cases of STIs. This will have to be taken into account in future studies” concludes Professor Jean-Michel Molina.
Source : Daily and on-demand HIV pre-exposure prophylaxis with emtricitabine and tenofovir disoproxil (ANRS PREVENIR): a prospective observational cohort studyThe Lancet HIV, June 2022
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